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Original Research: Disorders of the Pleura |

Survival in Patients With Malignant Pleural Effusions Who Developed Pleural InfectionMalignant Pleural Effusions and Pleural Infection: A Retrospective Case Review From Six UK Centers

Anna C. Bibby, MBChB; Amelia O. Clive, MBBS; Gerry C. Slade, RGN, FCCP; Anna J. Morley, RGN; Janet Fallon, MBBS; Ioannis Psallidas, PhD; Justin C. T. Pepperell, BMBCh; Mark G. Slade, MBBS; Andrew E. Stanton, MBChB; Najib M. Rahman, BMBCh; Nick A. Maskell, BMBS, FCCP
Author and Funding Information

From the Royal United Hospital NHS Trust (Dr Bibby), Combe Park, Bath; the North Bristol Lung Centre (Drs Clive and Maskell and Ms Morley), Southmead Hospital, North Bristol NHS Trust, Bristol; Papworth Hospital NHS Foundation Trust (Ms Slade and Dr Slade), Papworth Everard, Cambridge; Musgrove Park Hospital (Drs Fallon and Pepperell), Taunton, Somerset; the Oxford Centre for Respiratory Medicine (Drs Psallidas and Rahman), Churchill Hospital, Oxfordshire; Great Western Hospital NHS Trust (Dr Stanton), Swindon, Wiltshire; and the Academic Respiratory Unit (Dr Maskell), University of Bristol School of Clinical Sciences, Bristol, England.

CORRESPONDENCE TO: Nick A. Maskell, BMBS, FCCP, Academic Respiratory Unit, Second Floor, Learning and Research Bldg, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, England; e-mail: Nick.Maskell@bristol.ac.uk


This research was presented in abstract form (S117) at the British Thoracic Society Winter Meeting, December 5, 2014, London, England.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):235-241. doi:10.1378/chest.14-2199
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OBJECTIVE:  Malignant pleural effusion (MPE) incidence is increasing, and prognosis remains poor. Indwelling pleural catheters (IPCs) relieve symptoms but increase the risk of pleural infection. We reviewed cases of pleural infection in patients with IPCs for MPE from six UK centers between January 1, 2005, and January 31, 2014.

METHODS:  Survival in patients with pleural infection was compared with 788 patients with MPE (known as the LENT [pleural fluid lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, serum neutrophil to lymphocyte ratio, and tumor type] cohort) and with national statistics.

RESULTS:  Of 672 IPCs inserted, 25 (3.7%) became infected. Most patients (20 of 25) had mesothelioma or lung cancer. Median survival in the pleural infection cohort appeared longer than in the LENT cohort, although this result did not achieve significance (386 days vs 132 days; hazard ratio, 0.67; P = .07). Median survival with mesothelioma and pleural infection was twice as long as national estimates for mesothelioma survival (753 days vs < 365 days) and double the median survival of patients with mesothelioma in the LENT cohort (339 days; 95% CI, nonoverlapping). Survival with lung and breast cancer did not differ significantly between the groups. Sixty-one percent of patients experienced early infection. There was no survival difference between patients with early and late infection (P = .6).

CONCLUSIONS:  This small series of patients with IPCs for MPE suggests pleural infection may be associated with longer survival, particularly in patients with mesothelioma. Results did not achieve significance, and a larger study is needed to explore this relationship further and investigate whether the local immune response, triggered by infection, is able to modulate mesothelioma progression.

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